Senators Warren and Udall Unveil Bill to Guarantee Tribal Health Authorities Access to the Strategic National Stockpile

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Source: https://www.warren.senate.gov/newsroom/press-releases/senators-warren-and-udall-unveil-bill-to-guarantee-tribal-health-authorities-access-to-the-strategic-national-stockpile

Indian Health Service and other tribal health organizations currently lack guaranteed, direct access to federal repository of drugs and medical supplies for emergencies; Legislation would allow the Indian Health Service, tribal health authorities, and urban Indian organizations to access the Strategic National Stockpile and help combat the coronavirus crisis

Text of Bill (PDF) | One-Pager (PDF)

Washington, D.C. — United States Senators Elizabeth Warren (D-Mass.) and Senate Committee on Indian Affairs (SCIA) Vice Chairman Tom Udall (D-N.M.) today unveiled the Tribal Medical Supplies Stockpile Access Act, legislation that would guarantee that the Indian Health Service (IHS), tribal health authorities, and urban Indian organizations have access to the Strategic National Stockpile (SNS), a federal repository of drugs and medical supplies that can be tapped if a public health emergency could exhaust local supplies.

Currently, IHS and tribal health authorities’ access to the SNS is very limited and is not guaranteed in the SNS statute. In contrast, states’ and large municipalities’ public health authorities have ready access to the SNS. The lawmakers’ bill comes as the Department of Health & Human Services (HHS) indicated that IHS is likely to face shortages of necessary equipment as coronavirus disease 2019 (COVID-19) continues to spread.

“We must ensure that IHS, tribal nations, and Native communities are prepared to confront the coronavirus outbreak head-on, and that means ensuring that their health services have access to crucial medical supplies and equipment during public health emergencies,” Senator Warren said. “It is as important as ever to empower Indian Country to tackle a public health crisis, and that is what our bill does.”

“Tribal communities face unique challenges in responding to public health threats — that is why it is critical that we listen and respond to Tribal leaders and experts at IHS who say they are likely to face shortages of essential equipment and medical supplies that are needed to respond to this public health crisis,” said Senator Udall. “We must do everything we can to make sure Tribes don’t bear the worst costs of this public health crisis. This legislation will ensure that IHS facilities, Tribal health departments and urban Indian organizations have access to the emergency medical supplies they need. I will continue to push Congress and the Trump administration to make sure Indian Country has access to federal coronavirus resources and that there is meaningful engagement with Native communities and Tribal leaders in our response to COVID-19.”

The Tribal Medical Supplies Stockpile Access Act is supported by the National Indian Health Board, the National Congress of American Indians, the National Council of Urban Indian Health, United South and Eastern Tribes Sovereignty Protection Fund, Seattle Indian Health Board, and the Friends Committee on National Legislation.

“The COVID-19 pandemic has placed immense pressures on the chronically underfunded and under-resourced Indian health system. Direct access to the Strategic National Stockpile will bring much-needed relief and critical medical and pharmaceutical supplies into IHS, Tribal and urban Indian health facilities to prepare and respond to the current COVID-19 pandemic, and future health emergencies.” — National Indian Health Board

“We are encouraged by the leadership of Senator Warren and Senator Udall to increase health care access for American Indians and Alaska Natives through the Strategic National Stockpile. As the coronavirus continues to have greater impacts, Congress must do everything possible to uphold its trust responsibility to Indian Country by providing appropriate resources including N95 respirators. The stockpile is designed for those who need it most in times of emergency and Indian Country should not be left behind.” — Francys Crevier, Executive Director, National Council of Urban Indian Health

“We are grateful for the leadership of Senator Warren and Senator Udall and recognizing the importance of addressing the COVID-19 pandemic in American Indian and Alaska Native communities. Seattle Indian Health Board is right in the epicenter of the outbreak in the United States, and we continue to do everything possible to limit the spread of the virus while taking every safety precaution for our patients, staff, and community. This has come at the cost of revenue, staff, and resources. But with access to the Strategic National Stockpile, we can mitigate future impacts and continue to be leaders in addressing the COVID-19 pandemic.” — Esther Lucero, Chief Executive Officer, Seattle Indian Health Board

“As a Quaker organization who works to hold the United States to its trust and treaty obligations with Native nations, we thank Senators Warren and Udall for ensuring that American Indians and Alaska Natives are not forgotten during this global pandemic. The chronic underfunding of tribal and urban Indian health organizations has led Indian Country to be ill-prepared for a health crisis of this scale. Access to the Strategic National Stockpile will provide supplies and medicines critical to addressing the COVID-19 outbreak. Congress has a trust obligation to provide health facilities serving American Indians and Alaska Natives with the resources needed to protect the well-being of Native people and communities.” — Kerri Colfer, Congressional Advocate on Native American Policy at the Friends Committee on National Legislation

During her time in the Senate, Senator Warren has worked to protect and advance tribal sovereignty, to emphasize the federal government’s trust and treaty responsibilities to tribal nations, and to affirm Washington’s government-to-government relationship with tribal nations. She has introduced a number of bills to advance the health and welfare of Native peoples, including the Native American Suicide Prevention Act, the American Indian and Alaska Native Child Abuse Prevention and Treatment Act, and the Comprehensive Addiction Resources Emergency (CARE) Act, and has cosponsored other legislation to achieve that goal. She has also unveiled with Congresswoman Deb Haaland (D-N.M.) a proposal for the Honoring Promises to Native Nations Act, legislation that will address chronic underfunding and barriers to sovereignty in Indian Country.

In response to the coming economic downturn due to coronavirus, Senator Warren has called for a $750 billion economic stimulus package that would focus on recovery from the grassroots up, not Wall Street down. Such a package would apply the lessons from the 2008 bailout and provide direct help to families harmed by the coronavirus outbreak, including universal paid leave, increasing Social Security benefits by $200 a month, broad cancellation of student loan debt, and protecting and expanding housing.

 

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Udall Leads Bipartisan Group of Senators Urging Vice President Pence to Ensure Coronavirus Resources for Tribes and Urban Native Communities

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Call comes as first case is confirmed in Indian Country, and following Congressional approval of coronavirus emergency funding bill that includes $40 million in funds for Tribes, Tribal organizations and Urban Indian Health Organizations

WASHINGTON — Today, U.S. Senator Tom Udall (D-N.M.). vice chairman of the Senate Committee on Indian Affairs, led a bipartisan group of 27 senators in writing to Vice President Mike Pence requesting the administration meaningfully engage with Native communities and Tribal leaders on their response to the 2019 novel coronavirus (COVID-19).  The senators sent the letter following congressional passage of a coronavirus emergency supplemental appropriations bill that includes $40 million for Tribes, Tribal organizations and Urban Indian Health Organizations impacted by COVID-19.

In addition to Udall, the letter is signed by Senate Democratic Leader Chuck Schumer (D-N.Y.), and U.S. Senators Lisa Murkowski (R-Alaska), Jeff Merkley (D-Ore.), Dan Sullivan (R-Alaska), Ron Wyden (D-Ore.), Bernie Sanders (I-Vt.), Kamala Harris (D-Calif.), Jack Reed (D-R.I.), Tina Smith (D-Minn.), Elizabeth Warren (D-Mass.), Sheldon Whitehouse (D-R.I), Jacky Rosen (D-Nev.), Patty Murray (D-Wash.), Amy Klobuchar (D-Minn.), Martin Heinrich (D-N.M.), Jon Tester (D-Mont.), Dianne Feinstein (D-Calif.), Gary Peters (D-Mich.), Richard Blumenthal (D-Conn.), Tammy Baldwin (D-Wisc.), Cory Booker (D-N.J.), Brian Schatz (D-Hawaii), Debbie Stabenow (D-Mich.), Maria Cantwell (D-Wash.), Catherine Cortez Masto (D-Nev.), and Tammy Duckworth (D-Ill.).

The United States has confirmed COVID-19 cases in a number of states where Tribes and urban Indian communities are located. Given these developments and past issues accessing federal resources for the Zika, Ebola, H1N1, and SARS outbreaks, Tribes and Urban Indian Organizations are concerned that federal COVID-19 response efforts and resources will not reach them.

In their letter to the Vice President, the senators wrote, “As you undertake your work leading the Administration’s 2019 novel coronavirus (COVID-19) response, [we] urge you to meaningfully engage with Native communities and Tribal leaders.”

“The U.S. government has specific trust and treaty responsibilities to provide American Indians and Alaska Natives (AI/ANs) with comprehensive quality healthcare.  While the IHS serves as the primary agency charged with provision of AI/AN healthcare, all federal healthcare-related programs and initiatives – including the COVID-19 response – share equally in the requirement to fulfill these trust and treaty obligations,” the senators continued.

“Additionally, to ensure proper precautions and response measures are deployed efficiently, it is imperative that Tribal and urban Indian health teams have access to Congressionally-allocated COVID-19 resources and the most up-to-date information regarding the presence of COVID-19 in their communities,” wrote the senators.

The full text of the letter can be found below and HERE.

Dear Mr. Vice President,

As you undertake your work leading the Administration’s 2019 novel coronavirus (COVID-19) response, we urge you to meaningfully engage with Native communities and Tribal leaders.  Specifically, we ask that you ensure the Administration: 

– Includes a representative of the Indian Health Service (IHS) on the Administration’s COVID-19 task force;

– Provides Tribal leaders, Tribal health departments, and urban Indian health programs with equal access to COVID-19 related information that is provided to their state and local counterparts; and

– Directs all COVID-19 resources identified by Congress for Native communities’ use to impacted IHS facilities, Tribes, and urban Indian health programs in a timely manner.

The U.S. government has specific trust and treaty responsibilities to provide American Indians and Alaska Natives (AI/ANs) with comprehensive quality healthcare.  While the IHS serves as the primary agency charged with provision of AI/AN healthcare, all federal healthcare-related programs and initiatives – including the COVID-19 response – share equally in the requirement to fulfill these trust and treaty obligations.

Additionally, to ensure proper precautions and response measures are deployed efficiently, it is imperative that Tribal and urban Indian health teams have access to Congressionally-allocated COVID-19 resources and the most up-to-date information regarding the presence of COVID-19 in their communities.  As the IHS noted in its February 24th announcement, the state of the COVID-19 threat “is a rapidly evolving situation, and information is likely to become dated quickly.”[1]  As such, it is incumbent on the Administration to keep Indian Tribes, Tribal health departments, and urban Indian health programs apprised of any relevant developments in real time.

Thank you for your attention to these matters.  We look forward to working with you to uphold the Federal government’s Tribal trust and treaty responsibilities and to engage in meaningful government-to-government relations with Indian Tribes and urban Indian communities regarding the national COVID-19 response.

Sincerely,

Tribal Budget Formulation Work Group Recommends $196.8 Million for Urban Indian Health in FY 22

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NCUIH and UIO Leaders Attend FY 2022 IHS National Tribal Budget Work Session

On February 13 – 14, 2020, the Tribal Budget Formulation Work Group (TBFWG) convened in Arlington, Virginia to develop the National Tribal Budget Recommendation for fiscal year (FY) 2022. This is a two-day annual meeting where the two tribal representatives from each Indian Health Service (IHS) Area come together to review and consolidate all the Areas’ budget recommendations into a set of national health priorities and budget recommendations. During this year’s session, the TBFWG recommended a $90,900,000 increase to the Urban Indian Health budget line item from their FY 2021 recommendation made last year, which was approximately $105,900,000. This is a substantial increase from the recommendation in the FY 2021 President’s budget as the total TBFWG recommendation for Urban Indian Health, $196,800,000, nearly doubles the FY 2021 recommendation. The Urban Indian Health line item was listed as the 11th overall priority in the TBFWG’s National Tribal Budget Recommendation.

In addition, during this year’s session, the TBFWG recommended a $2,763,251,000 increase to the Program Expansion component of the FY 2022 IHS budget, which is a 30% increase over the FY 2021 budget recommendation. The National Council of Urban Indian Health (NCUIH) Board members, staff, and other Urban Indian Organization (UIO) leaders were in attendance at the National Tribal Budget Work Session, although no Urban Indian representative sits on the TBFWG.  Reports from several Areas made clear that UIOs had engaged thoroughly in their Area budget formulation meetings, leading to the TBFWG recommendation.  In fact, the Bemidji, Billings, California, Great Plains, Oklahoma, Phoenix, Portland, and Tucson Areas recommended an increase to Urban Indian Health, as indicated in the chart below.

Although NCUIH did not have an opportunity to present at the session, NCUIH Director of Federal Relations, Julia Dreyer, presented UIO budget priorities during an IHS webinar on January 29, 2020.

Region Recommended Increase for Urban Indian Health
Average 90,941
Alaska 0
Albuquerque 0
Bemidji 316,571
Billings 136,405
California 54,865
Great Plains 274,325
Nashville 0
Navajo 0
Oklahoma 137,163
Phoenix 46,314
Portland 70,786
Tucson 54,865

PRESS RELEASE: NCUIH Releases 2018-2019 Urban Indian Organization Shutdown Report

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FOR IMMEDIATE RELEASE
Contact: Meredith Raimondi
202-417-7781
mraimondi@ncuih.org

Report Shows Devastating Impacts of Shutdown and Highlights Urgency for Advance Appropriations and 100% FMAP

WASHINGTON, DC (February 14, 2020) – The National Council of Urban Indian Health (NCUIH) has released the 2018 – 2019 Urban Indian Organization Shutdown Report. The report summarizes and presents the results of a survey NCUIH circulated during the 2018-2019 shutdown to capture important metrics and narratives regarding its impacts. The United States federal government shutdown of 2018-2019 occurred from midnight Eastern Standard Time on December 22, 2018 until January 25, 2019. Nineteen out of forty-one Urban Indian Organizations (UIOs) reported. The responses from this survey were used in NCUIH’s policy and legislative advocacy initiatives during and after the shutdown. Although the Indian health care delivery system consists of three prongs — Indian Health Service (IHS), Tribal Health Programs, and UIOs — the report focuses on UIOs.

“The 2018-2019 Urban Indian Organization Shutdown Report demonstrates that the longest U.S. government shutdown in history had instant, longstanding, and severe negative impacts on UIOs and the American Indians and Alaska Natives (AI/ANs) they serve across the country. The federal trust responsibility to provide for the healthcare of all AI/ANs mandates that federal funding problems be fixed so that the impacts of any future shutdowns are minimized, and the lives of AI/ANs are not put at risk. Because UIOs operate on very low margins, every aspect of their abilities to deliver essential healthcare was affected by the 2018-2019 shutdown, including their abilities to hire and retain staff, to provide direct services, and, in some cases, even to remain open and available for their patients. IHS funding at the level of need, an increase in the Urban Indian Health budget line item, advance appropriations, and 100% FMAP for UIOs are all necessary fixes to protect the delivery of healthcare to AI/ANs,” said Francys Crevier, Executive Director of NCUIH.

The interruption in funding precipitated by the shutdown had dire consequences for UIOs and, consequently, on American Indians and Alaska Natives (AI/ANs) across the country. The impact on AI/ANs, many of whom depend on UIOs for their healthcare needs, ranged from patients unable to get vital medication for chronic conditions to fatal overdoses. UIOs had to make difficult decisions regarding cancellation of certain services, reduction in practitioner hours, staff retention, facility operation, and whether to use savings earmarked for other purposes to shield staff and patients from the impact of the shutdown.

NCUIH shifted its policy and advocacy focus during the shutdown to limit the disruptions to the daily operations of the UIOs it represents and urged Congress and the administration to immediately end the shutdown and restore funding to IHS. Following the shutdown and restoration of funding, NCUIH remains dedicated to establishing safeguards for UIOs against potential shutdowns in the future. NCUIH is working with Congressional officials to raise awareness for bills that would provide the Indian Health Service (IHS) with advance appropriations (H.R. 1128, S. 229) and provide 100% Federal Medical Assistance Percentage (FMAP) for UIOs (H.R. 2316, S. 1180).

Key Findings

UIOs operate on very low margins.

  • UIOs operate on very low margins such that even very minor changes to their funding structures lead to devastating impacts on the services they provide to AI/ANs and even affect their abilities to keep their facilities operational.

All aspects of the urban Indian healthcare delivery system were impacted by the shutdown, but the UIO workforce was the first to experience its disastrous effects.

  • The survey results point to a pattern which suggests that among the difficult decisions UIOs were forced to make during the 2013 and the 2018-2019 shutdowns, delaying hiring, reducing hours, and laying off staff were typically the first decisions made.

UIO services were greatly impacted.

  • Another pattern the survey highlighted is that UIOs were forced to cut back on services that were not as consequential as others, such as dental services, transportation, case management, and community outreach services. However, some UIOs were forced to cut even the essential services such as substance abuse services and purchase requests for diabetes and blood pressure medications.

UIOs were forced to use savings designated for other purposes to shield staff and patients from the impact of the last two government shutdowns.

  • Yet another pattern illustrated in the survey results suggests that UIO leaders made an effort to protect their staff and current services by using savings earmarked for program growth.

President’s FY 2021 Budget Proposal Includes $50 Million for Urban Indian Health

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The Request for FY 2021 is an Increase of $1 Million from FY 2020 Request, $8 Million Below FY 2020 Enacted

President Trump delivered a fiscally conservative budget proposal for FY2021. Although Congress and the President will negotiate new funding levels once the caps expire in September 2021, the President and congressional leaders had previously settled on new funding caps for the fiscal year ahead. The total Health and Human Services (HHS) budget is set at $96.4 billion which represents a nearly 10 percent cut to its most recent budget and includes $6.2 billion in Indian Health Service (IHS) funds.

Urban Indian Line Item

  • The spending proposal recommends a funding level for the urban Indian line at $49,636,000. This is an $8 million decrease from the enacted budget for FY 2020, but it is a $1 million increase from the President’s FY 2020 budget request for the line item. Meanwhile, IHS received an overall increase of $185 million.

Special Diabetes Program for Indians (SDPI)

  • President Trump’s budget also includes continued funding for the Special Diabetes Program for Indians (SDPI) at the current funding levels of $150 million through FY 2021.

Federal Tort Claims Act

  • The budget expands the Federal Tort Claims Act to Urban Indian Organizations (UIOs), which would protect UIO employees from malpractice lawsuits, saving each UIO an estimated $100,000 annually in malpractice insurance.

105(l) Leases

  • The FY 2021 budget adds $101 million for 105(l) leases. IHS was forced to reallocate $72 million in FY 2019 to pay $101 million for leases under section 105(l) of The Indian Self-Determination and Education Assistance Act (ISDEAA). Approximately $782,000 of which came from urban medical inflation funds.

Centers for Disease Control and Prevention and National Institutes of Health

  • The budget request would trim funding for the Centers for Disease Control and Prevention by almost 16 percent.  Funding loss that would affect the HHS core mission of preventing and controlling emerging public health issues such as opioid abuse.  The President proposes to give the National Institutes of Health a $38 billion budget for FY2021 – about $3 billion less than the current funding level. This cut would affect priorities to include research on the opioid epidemic and stimulants such as methamphetamine, issues that are at critical levels in Indian Country.

National Health Service Corps

  • The National Health Service Corps loan repayment program is reauthorized with $15 million – UIOs employees of UIOs are eligible for participation in the loan repayment program.

HIV/AIDS at HRSA

  • New programs include a focus on HIV/AIDS with $302 million allocated to Health Resources and Service Administration (HRSA) for HIV prevention diagnosis services expansion at health centers and treatment through the Ryan White HIV/AIDS program.

Quick Glance

  • $6,232,568,000 – IHS budget authority total
  • $4,507,113,000 – IHS services budget
  • $49,636,000 million – Urban Indian Health
  • $150,000,000 million – Special Diabetes Program for Indians
  • $101,000,000 million – Section 105(l) ISDEAA
  • $15,000,000 million – The National Health Service Corps loan repayment program
  • $302,000,000 million – HRSA for HIV prevention

A more in-depth analysis of the White House’s FY 2021 Budget is forthcoming.

NCUIH Contact: Carla Lott (cmlott@ncuih.org), Director of Congressional Relations

Distribution of the Fiscal Year (FY) 2020 Urban Indian Health Funding Increase

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On January 27, 2020, Indian Health Service (IHS) Deputy Director, Michael D. Weahkee, sent out a Dear Urban Indian Organization Leader Letter (DULL) regarding the IHS’s decision on the distribution of funds for the fiscal year (FY) 2020 increase. The letter provides that IHS issued the standard distribution of funds in accordance with the 2018 Urban Confer. 10 percent of the funds will be distributed to the Office of Urban Indian Health Programs (OUIHP) and 90 percent of the funds will be distributed to Urban Indian Organizations (UIOs) via IHS contracts. An equitable distribution methodology will divide the 90 percent evenly among the UIOs for FY 2020.

The DULL provides that the Urban Indian Health funding increase available for distribution in FY 2020 to the OUIHP and UIOs is $5,000,000. The Agency will move forward with distribution as outlined below:

FY 2020 Urban Indian Health Funding Increase – Category

Total Amount

Percentage of Funds
OUIHP

$500,000

10%
39 UIOs: $115,385 per Urban Indian Organization

$4,500,000

90%
Total FY 2020 Funding Increase Distribution

$5,000,000

100%

Why is this important to UIOs?

  • This is the UIOs overall funding distribution increase for FY 2020.
NCUIH Contact: Julia Dreyer (jdreyer@ncuih.org), Director of Federal Relations

Transfer of Former NIAAA Programs from ASAP to OUIHP is Complete

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On January 27, 2020, Indian Health Service (IHS) Principal Deputy Director, Michael D. Weahkee, sent out a Dear Urban Indian Organization Leader Letter (DULL) informing UIOs that the transfer of the former National Institute on Alcohol Abuse and Alcoholism programs (NIAAA) from the IHS Alcohol and Substance Abuse Program (ASAP) to the IHS Office of Urban Indian Health Programs (OUIHP) had been completed.

The DULL notes that IHS has completed three critical steps, which were previously identified. Accordingly, each former NIAAA program is defined as a UIO under the Indian Health Care Improvement Act, the internal management of contract funds have been transferred from the ASAP to the OUIHP, and IHS took steps to formally reprogram funds from the ASAP budget to the Urban Indian Health budget for fiscal year 2020.

Why is this important to UIOs?
  • IHS is informing UIOs that the actions needed to complete the transfer of former NIAAA programs to OUIHP, as identified in an October 13, 2017 DULL, have been completed.

NCUIH Contact: Julia Dreyer (jdreyer@ncuih.org), Director of Federal Relations

NCUIH to Testify before House Interior Appropriations

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Washington, DC (February 10, 2020) – On Tuesday, February 11, 2020, National Council of Urban Indian Health President Maureen Rosette (Chippewa Cree Nation) will testify before the House Interior Appropriations Subcommittee as part of American Indian and Alaska Native Public Witness Days (February 11 and 12, 2020). The hearing will begin at 9:00 AM at 2008 Rayburn House Office Building and will be livestreamed. Ms. Rosette is expected to testify at 10:10 AM during the Health Care Panel.

In the testimony, NCUIH will advocate for an increase in funding to a minimum of $81 to $106 million for the Indian Health Services (IHS) urban Indian healthcare line item, constituting 2% of the total IHS budget. The higher end of this range, $106 million, is what the IHS Tribal Budget Formulation Workgroup requested minimum is for Fiscal Year (FY) 2021. The House included $81 million in FY 2020 for urban Indian health and the final bill included $57 million, a $6 million increase.

NCUIH is grateful to be included in the Public Witness Days. NCUIH has been encouraged by the strong leadership of Chair McCollum and Ranking Member Joyce for urban Indian health in FY 2020 and looks forward to continuing these efforts for FY 2021.

The deadline to submit written testimony is Friday, March 6th.

Fifth Circuit Hears Oral Argument on ICWA Case

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Last week, the U.S. Court of Appeals for the Fifth Circuit heard oral argument on the constitutionality of the Indian Child Welfare Act (ICWA).  As previously reported, the court agreed to rehear the case, Brackeen v. Bernhardt, en banc.  Of the sixteen judges hearing the case, six asked the majority of the questions.  Attorneys from the Department of Justice, Navajo Nation, and an attorney representing Cherokee Nation, Morongo Band of Mission Indians, Oneida Nation, and Quinault Indian Nation argued in defense of ICWA.  The states challenging ICWA were represented by the Texas Solicitor General.  An attorney representing individual plaintiffs also presented argument challenging ICWA.  As a reminder, the case centers around whether ICWA is unconstitutional on several bases — including whether it violates the Equal Protection Clause as a race-based statute.  A three-judge panel had previously held ICWA constitutional before the entire Fifth Circuit agreed to rehear the case en banc.

An audio recording of the oral argument is available here.

NCUIH will continue to monitor the case and provide updates as they become available.  Previously, in December 2019, NCUIH joined nearly 400 Tribes and Indian organizations in an amicus curiae brief filed in support of the Indian Child Welfare Act (ICWA).

NCUIH Submits Comments to CMS, HHS OIG

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On December 31, NCUIH submitted two sets of comments to the Centers for Medicare & Medicaid Services (CMS) and Department of Health & Human Services Office of the Inspector General (OIG), respectively.

NCUIH’s first comment letter was submitted pursuant to CMS’s request for information on the Medicare Program: Modernizing and Clarifying the Physician Self-Referral Regulations.  In the comments, NCUIH strongly encouraged CMS to create new exceptions to the physician self-referral law that are consistent with the trust responsibility to AI/ANs.

The second comments were on OIG’s proposed rule, Medicare and State Healthcare Programs: Fraud and Abuse; Revisions to Safe Harbors Under the Anti-Kickback Statute, and Civil Monetary Penalty Rules Regarding Beneficiary Inducements.  In the comments, NCUIH noted, among other things, the importance of care coordination agreements to the I/T/U system and opposed modifications that would effectively make the safe harbor completely unavailable to I/T/U facilities.The OIG proposed modifications to the existing safe harbor for local transportation. In general, transportation is a major challenge for Indian Country, tribes, and AI/AN people no matter where they reside. For Indian health care providers and their AI/AN patients, transportation poses a significant barrier to health care access. NCUIH commented on the proposed increase in the mileage limit and encouraged OIG to eliminate the mileage limit for Indian health programs altogether – or to further expand the limit for our health programs. You can also find a copy of the comments submitted by the CMS Tribal Technical Advisory Group here.